Will Amazon Pharmacy transform the pharmacy industry?

Amazon Pharmacy, the tech giant’s latest venture into healthcare, launched a mail-order pharmacy in November 2020. The venture provides mail prescription delivery for all patients, as well as the additional benefits of two-day prescription delivery and discounted medication prices for Amazon Prime members through the Prime Rx program. Patients can have providers send prescriptions directly to Amazon or Amazon can contact the provider on the patient’s behalf. Amazon Pharmacy complements Amazon PillPack, which sorts medications into small, individual packages based on the date and time of day they are to be taken. 

Effectively, Amazon is joining the existing pharmacy supply chain. Amazon Pharmacy works with pharmacy benefit managers to ensure its mail-order pharmacy service is included in pharmacy networks when prescriptions are filled with insurance. When insurance is not used, Amazon offers Prime members discounted pricing through its mail-order pharmacy or at participating retail locations. 

In this paper, Milliman professionals discuss whether Amazon Pharmacy will disrupt, conform, or lay the groundwork for future transformation in the pharmacy industry. 

COVID-19 results in the expansive use of telehealth

The COVID-19 crisis and the enforced lockdowns and shelter-in-place orders worldwide have accelerated the relevance and usage of telehealth, which has major implications for health insurers. The usage of telehealth has been limited historically. For example, 92% of U.S. consumers reported that they were not using telehealth prior to the onset of the COVID-19 pandemic. 

In this paper, Milliman professionals examine the current status of telehealth in major geographic markets, including the U.S., Europe, and Asia. They develop a framework for telehealth with its key market participants, including a typology of models of virtual care. They also explore insurer proposition design and cost containment. 

Will the emerging vaccines restore workplace normalcy for employers?

The U.S. Food and Drug Administration recently granted emergency approval for the Pfizer COVID-19 vaccine and approval of the Moderna vaccine followed shortly. In November, Pfizer and BioNTech announced a successful Phase 3 study of a vaccine against COVID-19 with an efficacy of over 90%. Days later, Moderna made a similar announcement with the development of a vaccine having an efficacy of nearly 95%. These announcements were met with renewed hope that life will soon return to pre-pandemic normalcy. 

Employers have become increasingly anxious to see a return to normal business practices after months of disruption due to COVID-19. The vaccines offer hope that businesses will be able to prepare to roll out plans to return to pre-pandemic practices in the near future. In this paper, Milliman’s Les Kartchner and Brent Jensen present considerations for employers as these new vaccines are made available. 

New price transparency regulatory considerations for hospitals

As of January 1, 2021, regulations require U.S. hospitals to post to their websites all of their negotiated payment rates in one sprawling machine-readable file, although many hospitals may not meet the initial deadline. The aim of the regulation is to increase price transparency with the goal that such transparency will lead to increased competition, improved customer choice, and ultimately lower prices. There will be challenges, though, to extract useful competitive information from the files. This article by Milliman professionals examines those challenges. 

What Medicare Advantage plan options are available to individuals of different racial and ethnic groups?

Are there differences in access to healthcare—specifically for Medicare Advantage (MA) plans—for racial and ethnic minorities? MA plans are offered in almost every county throughout the U.S., and the plan options available are specific to each county. Anyone living in one of those counties who is eligible for Medicare can enroll regardless of race or ethnicity. What is the impact of geography on the number and average characteristics of plans available to each ethnic and racial group?

This paper by Milliman’s Adam Barnhart and Mary Yeh evaluates the general enrollment MA plans available to individuals for different racial and ethnic groups in the United States. They examined plan options available to individuals aged 65 and over belonging to five different racial or ethnic groups (white, Black, Hispanic or Latino, Asian or Pacific Islander, or American Indian or Alaska Native) from 2016 to 2020.

Pharmacy Briefing: December 2020

Pharmacy Briefing is a monthly summary of select U.S. Food and Drug Administration (FDA) approvals and launches, treatment guidelines and research updates, and other newsworthy events that have the potential to impact commercial drug utilization or costs.

  • FDA grants Emergency Use Authorization for Pfizer/BioNTech COVID-19 vaccine
  • Amazon enters retail pharmacy sector, launches Amazon Pharmacy
  • United Kingdom approves Pfizer/BioNTech COVID-19 vaccine
  • Kaiser Family Foundation report describes COVID-19’s effect on national health spending and utilization
FDA Approvals and Launches
  • Sesquient (fosphenytoin injection) is approved to treat status epilepticus.
  • Flu treatment Xofluza (baloxavir marboxil) receives additional indication for use in flu prevention (post-exposure prophylaxis).
  • Oxlumo (lumasiran) is approved to treat primary hyperoxaluria type 1, a rare genetic disorder.
  • Orladeyo (berotralstat) is approved to treat hereditary angioedema.

FDA grants Emergency Use Authorization for Pfizer/BioNTech COVID-19 vaccine

  • The decision follows a recommendation from the agency’s Vaccines and Related Biological Products Advisory Committee.

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Amazon enters retail pharmacy sector, launches Amazon Pharmacy

  • The online pharmacy can service patients with or without insurance and provides free two-day delivery for Prime members.
  • The service currently comes with some limitations.
    • No option of 90-day fills or automatic refills.
    • Examples of unavailable products include diabetic testing supplies, schedule II-controlled substances, specialty medications, and liquid suspensions.

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Kaiser Family Foundation report describes COVID-19’s effect on national health spending and utilization

  • As of the third quarter (Q3) 2020, authors found a decrease of 2.4% in non-pharmaceutical health spending relative to the same period in 2019.
  • As of October 2020, pharmaceutical spending increased 6.3%.

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HHS and FDA under legal pressure against drug importation final rule

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FDA advisory committee rejects endorsement of investigational Alzheimer’s drug aducanumab

  • The drug, if approved, would be the first Alzheimer’s treatment approved in over 17 years.

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U.S. Department of Health and Human Services (HHS) Special Fraud Alert warns against prescription kickback loophole

  • The alert highlights the practice of drug manufacturers awarding high-prescribing healthcare providers with speaking deals worth potentially hundreds of thousands of dollars.
  • HHS cautions that this practice violates federal anti-kickback statutes.

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OptumRx publishes Q4 Drug Pipeline Insights Report

  • The report highlights five drugs with FDA decisions in the near future, including novel cholesterol drug inclisiran.

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United Healthcare delays implementation of Accumulator Adjustment – Medical Benefit program

  • The program faced public backlash from several groups including the American Academy of Family Physicians and American Medical Association.

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Clinical Trials and Research

Pfizer/BioNTech and Moderna produce positive COVID-19 vaccine trial results

  • As a result of the clinical trial data, the manufacturers of the two vaccines have submitted requests for Emergency Use Authorization to the FDA.
  • The vaccines require two separate doses to achieve full efficacy.

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United Kingdom becomes first country to approve a COVID-19 vaccine

  • The country approved the vaccine developed by manufacturers Pfizer and BioNTech.
  • As of December 9, Bahrain and Canada have also approved the same product.

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Investigational long-acting HIV drug, cabotegravir, achieves endpoints in superiority trial

  • The injectable drug is dosed once every two months and was found to be more effective than daily Truvada (emtricitabine/tenofovir disoproxil fumarate) at preventing HIV transmission in women.

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